Ritalin or recess: Why are so many kids on ADHD meds?

More than 15 percent of U.S. children have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), including more than a fifth of teenage boys, writes Paul Tough in New York Times Magazine. The numbers have more than tripled in 30 years.

He thinks it's time to rethink our view of ADHD as a medical disorder best treated by stimulants such as Ritalin and Adderall, Tough argues. Scientists are "uncovering new evidence for the role of a child’s environment" and the limitations of medications.

Ritalin and Adderall are very effective in improving students' behavior, he writes. They're able to control their impulses, focus and do classwork. But ADHD drugs have little or no effect on academic achievement, studies have found. Effects seem to wear off after the first year, though that's in part because many teenagers stop taking them regularly. But there is a long-term effect on growth: Kids who take ADHD meds end up shorter.

ADHD symptoms fluctuate significantly over the years for most young people, concludes a new study, Tough reports. About a third of children with ADHD diagnoses are at high risk of negative outcomes in life, estimates Joel Nigg, a clinical psychologist at Oregon Health & Science University. For others, their problems appear to be "situational."

Psychologist Edmund Sonuga-Barke thinks treatment "should be focusing on building environments that improve outcomes and mental health,” rather than on trying to alter brain chemistry.

Tough talks to teenagers who hate their ADHD meds, but aren't sure they can do schoolwork without them. "Their problem is the simple fact that high school can be really boring, and without medication, they have a low tolerance for boring stuff," he writes. They might do OK once they find the right school or the right job. Or they might needs meds not "to fix their defective brain but as a tool to make an inhospitable environment more tolerable."

Something is wrong with school if so many boys "have to be medicated" just to tolerate it, writes Joy Pullman in The Federalist.

"I checked the criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders and discovered three of my four boys meet it," she writes. So do most of her friend's sons. "There is nothing wrong with any of them that some robust, father-directed discipline, keeping a close eye on them, a good amount of real work, and a lot of play outside doesn’t fix."

Being male should be defined as a disorder, Pullman writes. "Needlessly drugging little boys who can’t sit still and shut up for eight hours a day is just one of the many evil consequences of treating masculinity as a disease."

Tough's story isn't just "provocative and controversial," responds Anni Layne Rodgers in ADDitude Magazine. It's "misrepresentative, biased and dangerous."

There are no biomarkers for ADHD, she concedes, but that's true for most psychiatric and developmental disorders. Many diseases can't be cured by medication, but symptoms can be alleviated.

ADHD drugs may not improve test scores, writes Rodgers, but that's only one goal. "Inexplicably, Tough did not report that that ADHD medication has been shown to reduce impulsivity and, by extension, the risks of car accidents, substance abuse, unplanned pregnancy, comorbid depression and anxiety, incarceration, self-harm, and suicide." Research shows "that stimulant medication use among individuals with ADHD reduces the risk of premature death by a staggering 19%."

People with ADHD benefit from "a combination of therapy and medication," known as “integrative treatment,” writes psychologist Wes Crenshaw, who's quoted by Tough. Drugs alone are rarely enough, but neither are lifestyle changes sufficient for the patients he sees.

Digital addiction is shortening attention spans for everyone. Parents need to limit screen time and maximize time for their children to live, move and interact in the real, physical world, "IRL" as they say. Schools need to minimize classroom distractions, ban personal devices and provide more recess or sports or dance. Is "be less boring" a realistic goal? Probably not.